OBJECTIVE: We present a 2D image overlay device to assist needle placement on computed tomography (CT) scanners MATERIALS AND METHODS: The system consists of a flat display, a semitransparent mirror mounted on the gantry When the physician looks at the patient through the mirror, the CT image appears to be floating inside the body with correct size, position as if the physician had 2D ’X-ray vision’ The physician draws the optimal path on the CT image The composite image is rendered on the display, thus reflected in the mirror The reflected image is used to guide the physician in the procedure In this article, we describe the design, various embodiments of the 2D image overlay system, followed by the results of phantom, cadaver experiments in multiple clinical applications RESULTS: Multiple skeletal targets were successfully accessed with one insertion attempt Generally, successful access was recorded on liver targets when a clear path opened, but the number of attempts, accuracy showed variability because of occasional lack of access Soft tissue deformation further reduced the accuracy, consistency in comparison to skeletal targets CONCLUSION: The system demonstrated strong potential for reducing faulty needle insertion attempts, thereby reducing X-ray dose, patient discomfort